| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,557 |
2,438 |
$132K |
| D0120 |
Periodic oral evaluation - established patient |
2,495 |
2,393 |
$56K |
| D0274 |
Bitewings - four radiographic images |
1,277 |
1,213 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
2,463 |
2,262 |
$37K |
| D0180 |
|
669 |
607 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,790 |
1,615 |
$23K |
| D9110 |
|
359 |
326 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
408 |
393 |
$11K |
| D1120 |
Prophylaxis - child |
96 |
94 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
109 |
104 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
55 |
37 |
$3K |
| D0330 |
Panoramic radiographic image |
33 |
32 |
$1K |
| D0272 |
Bitewings - two radiographic images |
25 |
25 |
$750.00 |
| D1999 |
|
68 |
58 |
$0.00 |
| D9987 |
|
13 |
12 |
$0.00 |